Heavy menstrual bleeding (HMB) is defined as bleeding that lasts for more than seven days or as the loss of more than 80mL of blood per mentrual cycle (1)The menstrual blood loss can be quantified by the use of a pictorial bleeding assessment chart (PBAC).
The PBAC-Score was initially validated by Higham et al. (2) With the PBAC-Score the women can capture the number of pads or tampons and also state the intensity through the assessment of the drenching.
The aim of this study was to establish a reference range for the PBAC-Score.
We analysed samples of 310 women with menorrhagia and 108 controls by conducting the following tests: Blood count, VWF:RCo, VWF:Ag, VWF:CB, VWF:multimers, Fibrinogen (Clauss), activities of FII, FV, FVII, FVIII (clotting and chromogenic), FIX, FX, FXI, FXII, FXIII. In all women the menstrual blood loss was quantified usind the PBAC-Score and the results were compared.
In 202 of 310 women (65.1%) a bleeding disorder could be detected. In those with a bleeding disorder, the distribution was as followed: 64% of these women had a von Willebrand disease, 7.2% FVII-deficiency, 7.7% FXIII-deficiency and the remaining 21.1% other mild factor dificiencies. The mean PBAC-Score in women with menorrhagia was 262 (range 31 – 4212) in our control group the mean PBAC-Score was 60 (range 8 – 97).
Attemps to measure the quantity of menstrual blood loss can be useful in clinical practice.
In our opinion the best cut of for the PBAC-Score is 100 with a sensitifity of 90% and a specifity of 100%.
We found a high correlation of a PBAC >100 and an inherited bleeding disorder, especially von Willebrand diesease. In 65.1% of our patients an abnormal coagulation was found. In 4 (3.7%) women of the control group slightly abnormal von Willebrand parameters could been dectected.
We validated the reference range for the PBAC-Score as 0 - 100.
Halimeh:Octapharma AG: Investigator Other, Research Funding.
